What is early-onset Bipolar Disorder?

Bipolar Disorder is a serious mental illness characterized by recurrent episodes of depression, mania, and/or mixed symptom states. These episodes cause unusual and extreme shifts in mood, energy, and behavior that interfere significantly with normal, healthy functioning. Manic symptoms include: Severe changes in mood - either extremely irritable or overly silly and elated Overly-inflated self-esteem; grandiosity Increased energy Decreased need for sleep - able to go with very little or no sleep for days without tiring Increased talking - talks too much, too fast; changes topics too quickly; cannot be interrupted Distractibility - attention moves constantly from one thing to the next Hypersexuality - increased sexual thoughts, feelings, or behaviors; use of explicit sexual language Increased goal-directed activity of physical agitation Disregard of risk - excessive involvement in risky behaviors or activities. Depressive symptoms include: Persistent sad or irritable mood Loss of interest in activities once enjoyed Significant change in appetite or body weight Difficulty sleeping or oversleeping Physical agitation or slowing Loss of energy Feelings of worthlessness or inappropriate guilt Difficulty concentrating Recurrent thoughts of death or suicide Symptoms of mania and depression in children and adolescents may manifest themselves through a variety of different behaviors. When manic, children and adolescents, in contrast to adults, are more likely to be irritable or prone to destructive outbursts than to be elated or euphoric. When depressed, there may be many physical complaints such as headaches, muscle aches, stomachaches or tiredness, frequent absences from school or poor performance in school, talk of or efforts to run away from home, irritability, complaining, unexplained crying, social isolation, poor communication, and extreme sensitivity to rejection or failure. Other manifestations of manic and depressive states may include alcohol or substance abuse and difficulty with relationships. Existing evidence indicates that Bipolar Disorder beginning in childhood or early adolescence may be a different, possibly more severe, form of the illness than older adolescent- and adult-onset Bipolar Disorder. When the illness begins before or soon after puberty, it is often characterized by a continuous, rapid-cycling, irritable, and mixed symptom state that may co-occur with disruptive behavior disorders, particularly attention deficit hyperactivity disorder (ADHD) or conduct disorder (CD), or may have features of these disorders as initial symptoms. In contrast, later adolescent- or adult-onset Bipolar Disorder tends to begin suddenly, often with a classic manic episode, and to have a more episodic pattern with relatively stable periods between episodes. There is also less co-occurring with ADHD or CD among those with later onset illness. A child or adolescent who appears to be depressed or exhibits ADHD-like symptoms that are very severe, with excessive temper outbursts and mood changes, should be evaluated by a psychiatrist or psychologist with experience in Bipolar Disorder, particularly if there is a family history of the illness. This evaluation is especially important since psychostimulant medications, often prescribed for ADHD, may worsen manic symptoms. There is also limited evidence suggesting that some of the symptoms of ADHD may be a forerunner of full-blown mania. Findings from an NIMH-supported study suggest that the illness may be at least as common among youths as among adults. In this study, one percent of adolescents ages 14-18 were found to have met criteria for Bipolar Disorder or cyclothymia, a similar but milder illness, in their lifetime. In addition, close to six percent of adolescents in the study had experienced a distinct period of abnormally and persistently elevated, expansive, or irritable mood even though they never met full criteria for Bipolar Disorder or cyclothymia. Compared to adolescents with a history of major depressive disorder and to a never-mentally-ill group, both the teens with Bipolar Disorder and those with subclinical symptoms had greater functional impairment and higher rates of co-occurring illnesses (especially anxiety and disruptive behavior disorders), suicide attempts, and mental health services utilization. The study highlights the need for improved recognition, treatment, and prevention of even the milder and subclinical cases of Bipolar Disorder in adolescence. Bipolar Disorder in Children and Teens Does your child go through intense mood changes? Does your child have extreme behavior changes? Does your child get much more excited and active than other kids his or her age? Do other people say your child is too excited or too moody? Do you notice he or she has highs and lows much more often than other children? Do these mood changes affect how your child acts at school or at home? Some children and teens with these symptoms may have bipolar disorder, a serious mental illness. This brochure will give you more information. What is bipolar disorder? Bipolar disorder is a serious brain illness. It is also called manic-depressive illness or manic depression. Children with bipolar disorder go through unusual mood changes. Sometimes they feel very happy or “up,” and are much more energetic and active than usual, or than other kids their age. This is called a manic episode. Sometimes children with bipolar disorder feel very sad and “down,” and are much less active than usual. This is called depression or a depressive episode. Bipolar disorder is not the same as the normal ups and downs every kid goes through. Bipolar symptoms are more powerful than that. The mood swings are more extreme and are accompanied by changes in sleep, energy level, and the ability to think clearly. Bipolar symptoms are so strong, they can make it hard for a child to do well in school or get along with friends and family members. The illness can also be dangerous. Some young people with bipolar disorder try to hurt themselves or attempt suicide. Children and teens with bipolar disorder should get treatment. With help, they can manage their symptoms and lead successful lives. Who develops bipolar disorder? Anyone can develop bipolar disorder, including children and teens. However, most people with bipolar disorder develop it in their late teen or early adult years. The illness usually lasts a lifetime. Why does someone develop bipolar disorder? Doctors do not know what causes bipolar disorder, but several things may contribute to the illness. Family genes may be one factor because bipolar disorder sometimes runs in families. However, it is important to know that just because someone in your family has bipolar disorder, it does not mean other members of the family will have it as well. Another factor that may lead to bipolar disorder is the brain structure or the brain function of the person with the disorder. Scientists are finding out more about the disorder by studying it. This research may help doctors do a better job of treating people. Also, this research may help doctors to predict whether a person will get bipolar disorder. One day, doctors may be able to prevent the illness in some people. What are the symptoms of bipolar disorder? Bipolar “mood episodes” include unusual mood changes along with unusual sleep habits, activity levels, thoughts, or behavior. In a child, these mood and activity changes must be very different from their usual behavior and from the behavior of other children. A person with bipolar disorder may have manic episodes, depressive episodes, or “mixed” episodes. A mixed episode has both manic and depressive symptoms. These mood episodes cause symptoms that last a week or two or sometimes longer. During an episode, the symptoms last every day for most of the day. Children and teens having a manic episode may: Feel very happy or act silly in a way that’s unusual for them and for other people their age Have a very short temper Talk really fast about a lot of different things Have trouble sleeping but not feel tired Have trouble staying focused Talk and think about sex more often Do risky things Children and teens having a depressive episode may: Feel very sad Complain about pain a lot, such as stomachaches and headaches Sleep too little or too much Feel guilty and worthless Eat too little or too much Have little energy and no interest in fun activities Think about death or suicide Can children and teens with bipolar disorder have other problems? Young people with bipolar disorder can have several problems at the same time. These include: Substance abuse. Both adults and kids with bipolar disorder are at risk of drinking or taking drugs. Attention deficit/hyperactivity disorder (ADHD). Children who have both bipolar disorder and ADHD may have trouble staying focused. Anxiety disorders, like separation anxiety. Sometimes behavior problems go along with mood episodes. Young people may take a lot of risks, such as driving too fast or spending too much money. Some young people with bipolar disorder think about suicide. Watch for any signs of suicidal thinking. Take these signs seriously and call your child’s doctor. How is bipolar disorder diagnosed? An experienced doctor will carefully examine your child. There are no blood tests or brain scans that can diagnose bipolar disorder. Instead, the doctor will ask questions about your child’s mood and sleeping patterns. The doctor will also ask about your child’s energy and behavior. Sometimes doctors need to know about medical problems in your family, such as depression or alcoholism. The doctor may use tests to see if something other than bipolar disorder is causing your child’s symptoms. How is bipolar disorder treated? Right now, there is no cure for bipolar disorder. Doctors often treat children who have the illness in much the same way they treat adults. Treatment can help control symptoms. Steady, dependable treatment works better than treatment that starts and stops. Treatment options include: Medication. There are several types of medication that can help. Children respond to medications in different ways, so the right type of medication depends on the child. Some children may need more than one type of medication because their symptoms are so complex. Sometimes they need to try different types of medicine to see which are best for them. Children should take the fewest number of medications and the smallest doses possible to help their symptoms. A good way to remember this is “start low, go slow.” Medications can cause side effects. Always tell your child’s doctor about any problems with side effects. Do not stop giving your child medication without a doctor’s help. Stopping medication suddenly can be dangerous, and it can make bipolar symptoms worse. Therapy. Different kinds of psychotherapy, or “talk” therapy, can help children with bipolar disorder. Therapy can help children change their behavior and manage their routines. It can also help young people get along better with family and friends. Sometimes therapy includes family members. What can children and teens expect from treatment? With treatment, children and teens with bipolar disorder can get better over time. It helps when doctors, parents, and young people work together. Sometimes a child’s bipolar disorder changes. When this happens, treatment needs to change too. For example, your child may need to try a different medication. The doctor may also recommend other treatment changes. Symptoms may come back after a while, and more adjustments may be needed. Treatment can take time, but sticking with it helps many children and teens have fewer bipolar symptoms. You can help treatment be more effective. Try keeping a chart of your child’s moods, behaviors, and sleep patterns. This is called a “daily life chart” or “mood chart.” It can help you and your child understand and track the illness. A chart can also help the doctor see whether treatment is working. How can I help my child or teen? Help begins with the right diagnosis and treatment. If you think your child may have bipolar disorder, make an appointment with your family doctor to talk about the symptoms you notice. If your child has bipolar disorder, here are some basic things you can do: Be patient. Encourage your child to talk, and listen to your child carefully. Be understanding about mood episodes. Help your child have fun. Help your child understand that treatment can make life better. How does bipolar disorder affect parents and family? Taking care of a child or teenager with bipolar disorder can be stressful for you, too. You have to cope with the mood swings and other problems, such as short tempers and risky activities. This can challenge any parent. Sometimes the stress can strain your relationships with other people, and you may miss work or lose free time. If you are taking care of a child with bipolar disorder, take care of yourself too. Find someone you can talk to about your feelings. Talk with the doctor about support groups for caregivers. If you keep your stress level down, you will do a better job. It might help your child get better too. Where do I go for help? If you’re not sure where to get help, call your family doctor. You can also check the phone book for mental health professionals. Hospital doctors can help in an emergency. Finally, the Substance Abuse and Mental Health Services Administration (SAMHSA) has an online tool to help you find mental health services in your area. You can find it here: https://findtreatment.samhsa.gov . I know someone who is in crisis. What do I do? If you know someone who might be thinking about hurting himself or herself or someone else, get help quickly. Do not leave the person alone. Call your doctor. Call 911 or go to the emergency room. Call National Suicide Prevention Lifeline, toll-free: 1-800-273-TALK (8255). The TTY number is 1-800-799-4TTY (4889). For more information on conditions that affect mental health, resources, and research, go to MentalHealth.gov at http://www.mentalhealth.gov , or the NIMH website at http://www.nimh.nih.gov. In addition, the National Library of Medicine’s MedlinePlus service has information on a wide variety of health topics, including conditions that affect mental health. National Institute of Mental Health Office of Science Policy, Planning, and Communications Science Writing, Press, and Dissemination Branch 6001 Executive Boulevard Room 6200, MSC 9663 Bethesda, MD 20892-9663 Phone: 301-443-4513 or 1-866-615-NIMH (6464) toll-free TTY: 301-443-8431 or 1-866-415-8051 toll-free Fax: 301-443-4279 Email: nimhinfo@nih.gov Website: http://www.nimh.nih.gov U.S. Department of Health and Human Services National Institutes of Health National Institute of Mental Health NIH Publication No. QF 15-6380 Revised 2015 http://www.ryanlichtsangbipolarfoundation.org/site/c.ltJZJ8MMIsE/b.2107349/k.4471/What_is_earlyonset_Bipolar_Disorder.htm